102 - The First Week

The first week of having a new baby is full of surprises, but it's important that you know what to expect. In this episode, Dr. Carole Keim MD talks about what she wishes she knew the first week of having a new baby. She walks you through what is normal and what can be scary for a new mom. She also goes into detail on what moms can expect for themselves after welcoming home their adorable little one!

Dr. Carole Keim MD covers hormones, postpartum depression and the use of the Edinburgh Postnatal Depression Scale. From the first diaper change, breastfeeding, skin care, right up to your baby's first doctor's visit, there is a lot of information in this episode. However, you are going to be glad to have it to make that first week less scary. Also, remember that it’s normal to feel a little sad, overwhelmed, and exhausted.

At this age, your baby is doing a lot of things that seem scary but are actually normal.

Emotions: (00:32)

• Bonding with baby
• Baby blues
• Signs of postpartum depression

Pooping: (01:33)

• Meconium
• Transitional stool colors
• Seedy yellow - what are the seeds?
• Number of poops: 1 in first 48h of life, a few times on days 3-4, then every feed once milk surges

Peeing: (02:35)

• Brick dust / rusty pipes
• Pee once in the first 24h, 2-4x until milk surges, then by 1 week of age with each feed
• Concentrated urine x 3 days
• Normal pee

Eating / breastfeeding: (03:22)

• Painful x 2 weeks
• Takes baby 2 weeks to really learn how to do it
• Tongue ties, lip ties, cheek ties - when to fix them, baby has to re-learn how to eat
  • Fix if W shaped tongue, can’t stick out tongue past lips, inadequate weight gain. Some people fix due to nipple pain

Skin: (07:10)

• Bath x 9 mos, they’re going to peel
• Can use aquaphor/vaseline/unscented baby lotion
• Normal newborn rash

Diaper rash: (08:32)

• Uncommon at first but can happen
• Use wipes for poop only, not for pee
• If baby has a rash, could be irritation from wipes or diaper brand

Baby girls vs. boys: (09:11)

• Pseudomenses
• Circumcision after care
• Intact care

Breathing patterns: (12:03)

• Fast then slow

Belly button care and when it falls off: (12:30)

The first two checkups: (13:19)

• Typically 2-3 days after going home, or DOL 3-5, f/up 1 week (earlier if concern for weight or jaundice)
• First Hep B vaccine if they didn’t get it in the hospital
• Check weight; often down from BW
• Check if mom’s milk is in yet and what color poops are to assess jaundice risk
• Check for signs of PPD
• PE: Look at skin for jaundice, rashes (some normal, some deadly). Heart, lungs, organs, eyes, genitals, sacral dimple, spina bifida, hip clicks, fontanels, sutures mobile
• Neuro/devel: grasp reflex, rooting/suckling reflex, moro reflex, turns towards parents voice, communicates needs (hungry/wet), fixes briefly on faces, lift head when prone / on parent’s chest

Anticipatory guidance: (18:15)

• Eating - nothing but breast milk or formula for 4-6 months
• Mom should eat a wide variety of foods and take PNV while breastfeeding
• Supplement with 400 IU of vit D daily, or mom can take 6400 IU
• Sleep: back to sleep, nothing else in the crib. ABC = Alone, on Back, in Crib
• Fever and how to take temp
• Jaundice precautions, why jaundice happens, when it’s dangerous
• Never leave baby on high surface
• Rear facing car seat til age 2
• Avoid secondhand smoke
• Bathing baby - wait til umbilical stump falls off; then once/wk
• Skin care / peeling skin
• Tummy time

Resources discussed in this episode:

• The Baby Manual - Available on Amazon
• Edinburgh Postnatal Depression Scale - Downloadable

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